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SOUTH LAKELAND DISTRICT COUNCIL Public Health & Licensing Group, South Lakeland House, Lowther Street,

Kendal, Cumbria LA9 4UD Tel: 0845 050 4434 Fax: (01539) 740300

www.southlakeland.gov.uk e-mail: licensing@southlakeland.gov.uk

Application to vary a premises licence under the Licensing Act 2003

PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST

Before completing this form please read the guidance notes at the end of the form. If you are completing this form by hand please write legibly in block capitals. In all cases ensure that your answers are inside the boxes and written in black ink. Use additional sheets if necessary.

You may wish to keep a copy of the completed form for your records .

I/We (Insert name(s) of applicant)

being the premises licence holder, apply to vary a premises licence under section 34 of the Licensing Act 2003 for the premises described in Part 1 below

I Premises licence number ~L(. t-\~ c:)'7cE,

Part 1 - Premises Details

Postal address of premises or, if none, ordnance survey map reference or description

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(Fo~~EE::L't e.o ~~Td~ rs\~~~ OD~\\lS ~\.)~~ ~W~ e~ W\)...)~~~

Telephone number at premises (if any)

Non-domestic rateable value of premises £ \:8,756

South lakel,md fl#lr:jGI Council Public Protection

1 0 FEB 2016

Receipt No •••• ,~ •• l;¼..J.L.i~ ... "-• Initials .•••••••••••• ~.~ ................. .

Date •••• ..J.e0..~.P-l.!..Lk ............. .

October 2012

Page 2 of 18

Part 2 - Applicant details

Daytime contact telephone number

E-mail address (optional)

Current postal address if different from premises address

Post town I Postcode

Part 3 - Variation

Please tick as appropriate

Do you want the proposed variation to have effect as soon as possible? No Co yyyy OD MM

If not, from what date do you want the variation to take effect? I _JI JI JI

Please describe briefly the nature of the proposed variation (Please see guidance note 1)

If your proposed variation would mean that 5,000 or more people are expected to attend the premises at any one time, please state the number expected to attend: Part 4 Operating Schedule

October 20 12

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Please complete those parts of the Operating Schedule below which would be subject to change if this application to vary is successful.

Provision of regulated entertainment Please tick all that apply

a) plays (if ticking yes, fill in box A) □ b) films (if ticking yes, fill in box B) □ c) indoor sporting events (if ticking yes, fill in box C) □ d) boxing or wrestling entertainment (if ticking yes, fill in box D) □ e) live music (if ticking yes, fill in box E) □ f) recorded music (if ticking yes, fill in box F) □ g) performances of dance (if ticking yes, fill in box G) □

h) anything of a similar description to that falling within (e), (f) or (g) (if ticking yes, fill in box H) □

i) Provision of late night refreshment (if ticking yes, fill in box I) □ j) Sale by retail of alcohol (if ticking yes, fill in box J) □ In all cases complete boxes K, L and M

October 2012

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A

Plays Will the performance of a play take place indoors

□ Standard days and or outdoors or both - please tick (please read Indoors timings (please read guidance note 2) guidance note 6)

Outdoors □ Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State any seasonal variations for performing plays (please read guidance note 4)

Thur

Fri Non standard timings. Where you intend to use the premises for the performance of plays at different times to those listed in the column on the left, please list (please read guidance note 5)

Sat

Sun

October 2012

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B

Films Standard days and timings (please read guidance note 6)

Will the exhibition of films take glace indoors or outdoors or both - glease tick (please read guidance note 2)

Indoors □

Outdoors □ Day Start Finish Both □ Mon Please give further details here {please read guidance note 3)

Tue

Wed State any seasonal variations for the exhibition of films {please read guidance note 4)

Thur

Fri Non standard timings. Where you intend to use the 12remises for the exhibition of films at different times to those listed in the column on the left, 12lease list {please read guidance note 5)

Sat

Sun

October 201 2

C

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Indoor sporting events Standard days and timings (please read guidance note 6)

Please give further details (please read guidance note 3)

Day Start Finish

Mon

Tue State any: seasonal variations for indoor sporting events (please read guidance note 4)

Wed

Thur Non standard timings. Where you intend to use the premises for indoor sporting events at different times to those listed in the column on the left, please list (please read guidance note 5)

Fri

Sat

Sun

October 201 2

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D

Boxing or wrestling Will the boxing or wrestling entertainment take

□ entertainments Qlace indoors or outdoors or both - please tick Indoors Standard days and (please read guidance note 2) timings (please read

Outdoors □ guidance note 6)

Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State any seasonal variations for boxing or wrestling entertainment (please read guidance note 4)

Thur

Fri Non standard timings. Where you intend to use the premises for boxing or wrestling entertainment at different times to those listed in the column on the left, please list (please read guidance note 5)

Sat

Sun

October 2012

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E

Live music Will the Qerformance of live music take Qlace Standard days and indoors or outdoors or both - Qlease tick (please Indoors □ timings (please read read guidance note 2) guidance note 6)

Outdoors □ Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State any seasonal variations for the Qerformance of live music (please read guidance note 4)

Thur

Fri Non standard timings. Where you intend to use the Qremises for the Qerformance of live music at different times to those listed in the column on the left, Qlease list (please read guidance note 5)

Sat

Sun

October 2012

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F

Recorded music Will the 12laying of recorded music take 12lace

□ Standard days and indoors or outdoors or both - 12lease tick (please Indoors timings (please read read guidance note 2) guidance note 6)

Outdoors □ Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State any seasonal variations for the 12laying of recorded music (please read guidance note 4)

Thur

Fri Non standard timings. Where you intend to use the 12remises for the 12laying of recorded music at different times to those listed in the column on the left, 12lease list (please read guidance note 5)

Sat

Sun

October 2012

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G

Performances of dance Standard days and timings (please read guidance note 6)

Will the Qerformance of dance take Qlace indoors or outdoors or both - Qlease tick (please read guidance note 2)

Indoors □

Outdoors □ Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State an)l seasonal variations for the Qerformance of dance (please read guidance note 4)

Thur

Fri Non standard timings. Where )£OU intend to use the Qremises for the Qerformance of dance at different times to those listed in the column on the left, Qlease list (please read guidance note 5)

Sat

Sun

October 20 12

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H

Anything of a similar description to that falling within (e), (f) or (g) Standard days and timings (please read guidance note 6)

Please give a description of the type of entertainment you will be providing

Day Start Finish Will this entertainment take Place indoors or Indoors □ outdoors or both - please tick (please read guidance note 2) Mon Outdoors □

Both □ Tue Please give further details here (please read guidance note 3)

Wed

Thur State an)£ seasonal variations for entertainment of a similar description to that falling within {e}1 m or {g} (please read guidance note 4)

Fri

Sat Non standard timings. Where )£OU intend to use the premises for the entertainment of a similar description to that falling within {e}1 m or {g} at different times to those listed in the column on the left please list (please read guidance note 5)

Sun

October 2012

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Late night refreshment Standard days and timings (please read guidance note 6)

Will the Qrovision of late night refreshment take place indoors or outdoors or both -please tick (please read guidance note 2)

Indoors □

Outdoors □ Day Start Finish Both □ Mon Please give further details here (please read guidance note 3)

Tue

Wed State an)£ seasonal variations for the Qrovision of late night refreshment (please read guidance note 4)

Thur

Fri

Sat

Non standard timings. Where :tou intend to use the premises for the provision of late night refreshment at different times1 to those listed in the column on the left1 please list (please read guidance note 5)

Sun

October 2012

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J

Supply of alcohol Will the supply of alcohol be for consumption On the □ Standard days and - please tick (please read guidance note 7) premises

timings (please read guidance note 6) Off the

□ premises

Day Start Finish Both □ Mon State an~ seasonal variations for the su~pl~ of alcohol {please

read guidance note 4)

Tue

Wed

Thur Non-standard timings. Where ~ou intend to use the premises for the suppl~ of alcohol at different times to those listed in the column on the left, please list {please read guidance note 5)

Fri

Sat

Sun

K

Please highlight any adult entertainment or services, activities, other entertainment or matters ancillary to the use of the premises that may give rise to concern in respect of children {please read guidance note 8).

October 2012

L

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Hours premises are State any seasonal variations (please read guidance note 4) open to the public Standard days and timings (please read guidance note 6)

Day Start Finish

Mon C\•$ 01 · 01':J

Tue C\ 'e-z:::, ot , ~

Wed 0\,"7C 9 'cz.::,

Non standard timings. Where )£OU intend the eremises to be oeen to the eublic at different times from those listed in the

Thur o I , o:-:: 9 I e::c:> column on the left, elease list (please read guidance note 5)

Fri -=\,O"C) 0 \ ' <::e::>

Sat A,, cn:::r o \ ,o:::~

Sun =t rei'.:> 0 \ ~

Please identify those conditions currently imposed on the licence which you believe could be removed as a consequence of the proposed variation you are seeking.

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October 2012

Pagel5of18

Please tick as appropriate

• I have enclosed the premises licence □ • I have enclosed the relevant part of the premises licence □

If you have not ticked one of these boxes, please fill in reasons for not including the licence or part of it below

Reasons why I have not enclosed the premises licence or relevant part of premises licence.

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M Describe any additional steps you intend to take to promote the four licensing objectives as a result of the proposed variation:

a General - all four licensing ob·ectives b, c, d and e (please read guidance note 9

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b The revention of crime and disorder

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c) Public safety

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October 2012

Page 16 of 18

d) The prevention of public nuisance

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e The protection of children from harm

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Checklist:

Please tick to indicate agreeme~

• I have made or enclosed payment of the fee. 0 • I have sent copies of this application and the plan to responsible authorities and d

others where applicable. ~

• I understand that I must now advertise my application. 0 • I have enclosed the premises licence or relevant part of it or explanati~n . ~ • I understand that if I do not comply with the above requirements my application will be ~ rejected.

IT IS AN OFFENCE, LIABLE ON SUMMARY CONVICTION TO A FINE NOT EXCEEDING LEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION.

Part 5 - Signatures (please read guidance note 10)

Signature of applicant (the current premises licence holder) or applicant's solicitor or other duly authorised agent (please read guidance note 11 ). If signing on behalf of the applicant, please state in what capacity.

Signature

Date

Capacity

Where the premises licence is jointly held, signature of 2nd applicant (the current premises licence holder) or 2nd applicant's solicitor or other authorised agent (please read guidance note 12). If signing on behalf of the applicant, please state in what capacity.

I Signature

Date

October 20 12

Page 17 of 18

I Capacity

Contact name (where not previously given) and address for correspondence associated with this application (please read guidance note 13)

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Post town

Notes for Guidance

This application cannot be used to vary the licence so as to extend the period for which the licence has effect or to vary substantially the premises to which it relates. If you wish to make that type of change to the premises licence, you should make a new premises licence application under section 17 of the Licensing Act 2003.

1 . Describe the premises. For example the type of premises, its general situation and layout and any other information which could be relevant to the licensing objectives. Where your application includes off-supplies of alcohol and you intend to provide a place for consumption of these off-supplies, you must include a description of where the place will be and its proximity to the premises.

2. Where taking place in a building or other structure please tick as appropriate (indoors may include a tent).

3. For example state type of activity to be authorised, if not already stated, and give relevant further details, for example (but not exclusively} whether or not music will be amplified or unamplified.

4. For example (but not exclusively), where the activity will occur on additional days during the summer months.

5. For example (but not exclusively), where you wish the activity to go on longer on a particular day e.g . Christmas Eve.

6. Please give timings in 24 hour clock (e.g. 16:00) and only give details for the days of the week when you intend the premises to be used for the activity.

7. If you wish people to be able to consume alcohol on the premises, please tick 'on the premises'. If you wish people to be able to purchase alcohol to consume away from the premises, please tick 'off the premises' . If you wish people to be able to do both, please tick 'both'.

8. Please give information about anything intended to occur at the premises or ancillary to the use of the premises which may give rise to concern in respect of children regardless of whether you intend children to have access to the premises, for example (but not exclusively) nudity or semi-nudity, films for restricted age groups or the presence of gaming machines.

9. Please list here steps you will take to promote all four licensing objectives together. 10. The application form must be signed. 11. An applicant's agent (for example solicitor) may sign the form on their behalf provided

that they have actual authority to do so. 12. Where there is more than one applicant, each of the applicants or their respective agents

must sign the application form. 13. This is the address which we shall use to correspond with you about this application.

October 201 2

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